Alendronate non-adherence is more likely in male veterans who smoke or report side effects, and less likely in men having bone densitometry during therapy. Providers urgently need programs to increase adherence to osteoporosis medications. Initial programs should target patients with risk factors for non-adherence.

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Background Some patients experience reduced bone mineral density (BMD) despite bisphosphonate therapy. We performed a retrospective chart review study to detect factors associated with decreased BMD in men prescribed alendronate. Methods Two investigators reviewed eligible medical records and used a standardized form to record potential characteristics predicting men’s response to alendronate. We analyzed patient characteristics associated with annualized change in hip and spine BMD (D-BMD). Results Among 115 eligible men, 19 (17%) experienced significantly decreased BMD at the hip or spine, defined as a change exceeding precision error. Eleven men (10%) fractured during therapy. Spine D-BMD was positively associated with adherence to alendronate (R = 0.23, p=0.02) and inversely associated with baseline body weight (R = −0.21, p=0.03). Hip D-BMD was positively associated with annualized weight change (R = 0.19, p=0.0498) and negatively associated with patient age and number of concomitant medications (R = −0.21, p=0.03; R = −0.20, p = 0.03, respectively). In stepwise linear models, spine D-BMD was positively associated with alendronate adherence and multivitamin use, and negatively with baseline body weight. Hip D-BMD was negatively associated with age. Fracture during treatment was associated with fracture prior to therapy (p=0.03) Conclusions In this small study of men prescribed alendronate, BMD response showed a positive association with adherence to therapy, weight gain, and use of a multivitamin. By contrast, older age, higher baseline body weight, and higher number of medications were each associated with a decrease in BMD. Larger studies are needed to confirm and extend these findings.